Dick Gephardt, the two-time presidential candidate and former House Democratic leader, has come out against the Independent Payment Advisory Board (IPAB), which is responsible for controlling Medicare costs under the Affordable Care Act. His reasoning? We don’t want to hand medical decisions to unelected bureaucrats, oh, and won’t someone think of the seniors?
Under the current law, IPAB will be an unelected and unaccountable group whose sole charge is to reduce Medicare spending based on an arbitrary target growth rate. It will propose cuts to Medicare that Congress can override only with supermajority votes, an unnecessarily high and unrealistic bar. Just as important, these cuts are likely to have devastating consequences for the seniors and disabled Americans who are Medicare’s beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them.
Unfortunately for Gephardt (and others who make this argument), we already live in a world where unelected, unaccountable groups devote their energies to reducing healthcare costs based on arbitrary (or at least, obscured) targets and growth rates. They’re called health insurers, and incidentally, they are big clients of Gephardt’s consulting group, Gephardt Government Affairs, which goes unacknowledged in the piece.
In any case, yes, IPAB is mostly isolated from electoral pressures, but like members of the federal judiciary or the Federal Reserve, IPAB members are subject to Senate confirmation. By the standards of our Constitution, IPAB is thoroughly democratic, and by the standards of health insurance companies, it’s a paradise of political participation.
As for seniors, Gephardt is simply scaremongering. There’s plenty of low-hanging fruit in Medicare, and IPAB can save a fair amount of money by ending payments for dubious procedures and inefficient providers. More importantly, Medicare compromises a huge part of the current healthcare system, and even with cheaper procedures, it’s still worthwhile for doctors and healthcare professionals to take Medicare patiences. What’s more, if Medicare cost control measures trickle down to private health insurers, doctors won’t find any advantage in rejecting Medicare patients.
